Tuesday, August 08, 2006

On call, post call

I have worked 25 hours in the last two days. Yesterday my team was on call, I did an H&P on a 61 year old man who came into the ER because his ankle hurt from dropping something on it on Friday. We admitted him because his blood pressure was about 80/50 and a blood glucose of 346 (normal is about 80-120). He has been dizzy for several months, with significant worsening over the last three days. He had a heart attack in 2000 for which he needed sextuple-bypass surgery (he needs 1-2 more bypasses), he has COPD, horribly controlled diabetes, atrial fibrillation, hypertension, hyperlipidemia, kidney failure (dramatically worsening in the last month), and a couple other things I can’t remember right now. We put the ankle pain at the bottom of the priority list.

I interviewed another patient who has pseudoseizures which I had never heard of before. Apparently (I can’t find much info on them) they are psychologically induced, but the patient is not doing them intentionally. I watched him have several, and they looked like real seizures, but he does not lose consciousness, can remember them, never bites his tongue or hurts himself, and he can talk during them. There isn’t really anything we can do for him, he was discharged this afternoon.

My endocarditis patient with worsening acute renal failure was all set to go to a transitional care unit. I talked to the social worker this morning, and she got the transitional care people to put him on the waiting list for a bed. Then he started coughing up blood this afternoon. It is most likely due to little bits of the infection in his heart breaking off and traveling to his lungs. The intern wasn't happy, the resident will be even less so when she comes in tomorrow.

Today, being a post-call day, was long because one of the interns, the resident, and the senior medical student had to leave at noon since they were at the hospital all of last night. The other intern and I had to make sure that all their patients had their labs and consults in. Tomorrow is short-call for my team, meaning that we admit patients in the morning, so hopefully I will get to do another H&P, because I really need the practice.


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